INDUCE

Bacterial colonisation

A spectrum of increasing presence of bacteria in an ulcer is recognised, from minor contamination to colonisation to pathogenic infection. The presence of bacteria in an ulcer becomes problematic when wound healing is delayed, at a point which may be referred to as the critically colonised or locally infected state.

At this point there is delayed healing but without the classical systemic indicators of infection. Here the use of antimicrobial dressings may be of benefit to reduce the bacterial burden. If the classical indicators of infection are present, such as erythema, increased pain or exudate, then systemic antibiotics should be initiated.

Prolonged use of topical antimicrobials should be avoided because they only provide short-term clinical benefit, topical sensitisation can result in allergy development, and antimicrobial dressings are generally more expensive than alternatives.

Table 3: The effects of increasing ulcer bacterial load